Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, USA.
Department of Diagnostic Radiology, University of Stellenbosch, Cape Town, South Africa.
Eur Radiol. 2020 Aug;30(8):4358-4368. doi: 10.1007/s00330-020-06789-7. Epub 2020 Mar 14.
OBJECTIVE: To compare quantitative chest CT parameters in perinatally HIV-infected adolescents with and without bronchiolitis obliterans compared with HIV-uninfected controls and their association with lung function measurements. MATERIALS AND METHODS: Seventy-eight (41 girls) HIV-infected adolescents with a mean age of 13.8 ± 1.65 years and abnormal pulmonary function tests in the prospective Cape Town Adolescent Antiretroviral Cohort underwent contrast-enhanced chest CT on inspiration and expiration. Sixteen age-, sex-, and height-matched non-infected controls were identified retrospectively. Fifty-one HIV-infected adolescents (28 girls) displayed mosaic attenuation on expiration suggesting bronchiolitis obliterans. Pulmonary function tests were collected. The following parameters were obtained: low- and high-attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume. RESULTS: HIV-infected adolescents showed a significantly higher mean lung density, ventilation heterogeneity, mass, and high- and low-attenuation areas compared with non-infected individuals. Kurtosis and skewness were significantly lower as well. HIV-infected adolescents with bronchiolitis obliterans had a significantly lower kurtosis and skewness compared with those without bronchiolitis obliterans. Lung mass and volume showed the strongest correlations with forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), and alveolar volume. Low-attenuation areas below - 950 HU and ventilation heterogeneity showed the strongest correlation with FEV/FVC (range, - 0.51 to - 0.34) and forced expiratory flow between 25 and 75% of FVC (range, - 0.50 to - 0.35). CONCLUSION: Quantitative chest CT on inspiration is a feasible technique to differentiate perinatally HIV-infected adolescents with and without bronchiolitis obliterans. Quantitative CT parameters correlate with spirometric measurements of small-airway disease. KEY POINTS: • Perinatally HIV-infected adolescents showed a more heterogeneous attenuation of the lung parenchyma with a higher percentage of low- and high-attenuation areas compared with non-infected patients. • Kurtosis and skewness are able to differentiate between HIV-infected adolescents with and without bronchiolitis obliterans using an inspiratory chest CT. • Quantitative CT parameters of the chest correlate significantly with pulmonary function test. Low-attenuation areas and ventilation heterogeneity are particularly associated with spirometric parameters related to airway obstruction.
目的：比较经产前感染 HIV 的青少年与无细支气管炎性阻塞的经产前感染 HIV 的青少年以及 HIV 未感染者的定量胸部 CT 参数，并分析这些参数与肺功能测量的相关性。
材料和方法：前瞻性开普敦青少年抗逆转录病毒队列研究中，78 名（41 名女孩）平均年龄为 13.8±1.65 岁的经产前感染 HIV 的青少年出现异常的肺功能检测结果，对其进行吸气和呼气时的对比增强胸部 CT。回顾性地选择了 16 名年龄、性别和身高匹配的未感染对照者。51 名经产前感染 HIV 的青少年（28 名女孩）呼气时显示出镶嵌性衰减，提示细支气管炎性阻塞。收集了肺功能测试。获得了以下参数：低衰减区和高衰减区、平均肺密度、峰度、偏度、通气异质性、肺质量和体积。
结果：与未感染个体相比，经产前感染 HIV 的青少年的平均肺密度、通气异质性、质量以及高低衰减区均显著升高，而峰度和偏度则显著降低。细支气管炎性阻塞的经产前感染 HIV 的青少年的峰度和偏度明显低于无细支气管炎性阻塞的青少年。肺质量和体积与用力呼气量 1 秒（FEV）、用力肺活量（FVC）和肺泡容积相关性最强。-950 HU 以下的低衰减区和通气异质性与 FEV/FVC（范围为-0.51 至-0.34）和 25%至 75%用力肺活量之间的用力呼气流量（范围为-0.50 至-0.35）相关性最强。
结论：吸气时的定量胸部 CT 是一种可行的技术，可以区分经产前感染 HIV 的青少年有无细支气管炎性阻塞。定量 CT 参数与小气道疾病的肺活量测定法测量结果相关。
重点：• 与未感染患者相比，经产前感染 HIV 的青少年的肺实质衰减更不均匀，高低衰减区的百分比更高。• 峰度和偏度可通过吸气性胸部 CT 区分经产前感染 HIV 的青少年有无细支气管炎性阻塞。• 胸部的定量 CT 参数与肺功能测试显著相关。低衰减区和通气异质性与与气道阻塞相关的肺活量测定参数特别相关。
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